Developing the Patient Experience Assessment Questionnaire for Hospital Inpatient Care in South Korea

Measuring patient experiences has become a key initiative for improving healthcare quality worldwide. Since patient experiences are inherently shaped by sociocultural context and healthcare system structures, developing locally relevant measurement tools is crucial for reflecting patients' needs and expectations. South Korea has developed a patient experience questionnaire for hospital inpatient care within its National Health Insurance system through a systematic process involving patient engagement. In outlining the development process of the questionnaire, this study assesses its psychometric properties, focusing on validity and reliability.

The Patient Experience Assessment (PXA) questionnaire was developed through a three-phase process: (1) item generation via a literature review and qualitative research with patient and caregiver groups, (2) expert review using the Delphi method, and (3) validity and reliability testing through a pilot test. After stakeholder feedback, the current version of PXA includes 21 items across 6 domains. Psychometric properties were assessed using data from 629 inpatients in four general hospitals, split into two subsamples for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to ensure robust construct validation. Internal consistency was assessed using Cronbach's alpha.

The PXA questionnaire includes globally recognised patient-centred themes while addressing unique issues that matter to patients in the Korean healthcare system. EFA identified a four-factor structure: (1) Information, dignity, and autonomy; (2) Communication with nurses; (3) Communication with doctors; and (4) Hospital environment. CFA confirmed this structure, demonstrating high convergent validity (standardised loadings > 0.70) and satisfactory model fit (CFI and TLI > 0.950, RMSEA = 0.036, SRMR = 0.046). The instrument showed excellent reliability (Cronbach's alpha: total = 0.95; subscales = 0.89-0.93).

The PXA questionnaire, currently being implemented in South Korea, demonstrates robust psychometric properties. This work also exemplifies the process of developing a locally relevant patient experience questionnaire, grounded in global knowledge on patient-centred care.

Patients and caregivers participated in focus group discussions during PXA development. Their opinions directly informed the identification of culturally specific patient experience dimensions relevant to the Korean healthcare system. These findings emphasise engaging target patient populations in developing locally relevant patient experience instruments.